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Calcareous Degeneration of Host-Donor Interface After Descemet Membrane Stripping With Automated Endothelial Keratoplasty

Ebrahimi, Katayoon B MD; Oster, Stephen F MD, PhD; Green, W Richard MD; Grebe, Rhonda MS; Schein, Oliver D MD, MPH; Jun, Albert S MD, PhD

doi: 10.1097/ICO.0b013e3181861c98
Case Report

Purpose: To report a case of host-donor interface calcification after Descemet membrane stripping with automated endothelial keratoplasty (DSAEK).

Methods: Review of the patient's clinical records and histopathologic examination of the donor corneal lamella from repeat DSAEK performed subsequent to the original DSAEK.

Results: Review of the clinical record of the patient revealed an ocular history of Fuchs dystrophy and pseudophakic bullous keratoplasty that was treated with DSAEK. She later developed corneal edema and a partially detached donor lamella and underwent repeat DSAEK. Histopathologic and transmission electron microscopic evaluations of the corneal lamella revealed calcium deposits in the host-donor interface.

Conclusions: Calcareous degeneration of the host-donor interface after DSAEK is reported as a novel postoperative complication of DSAEK. Calcium deposits in the host-donor interface after DSAEK should be considered in the differential diagnosis of interface opacity after this procedure, particularly in patients with predisposing systemic or local risk factors such as retained phosphate-containing viscoelastic material, excessive postoperative inflammation, or use of phosphate-buffered, postoperative topical medications.

From the *Eye Pathology Laboratory, Wilmer Eye Institute; †Department of Pathology; ‡Cornea and External Disease Service, Wilmer Eye Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.

Received for publication February 4, 2008; revision received June 17, 2008; accepted July 5, 2008.

Supported in part by the Medical Illness Counseling Center Grant Award (Chevy Chase, MD) to A.S.J. and the Wilmer Microscopy Core Facility Grant (NEI EY001765).

The authors have no financial or proprietary interests in this subject.

Reprints: Albert S. Jun, MD, PhD, Cornea and Anterior Segment Service, Wilmer Eye Institute, The Johns Hopkins Medical Institutions, Wilmer/Woods 474, 600 North Wolfe Street, Baltimore, MD 21287 (e-mail:

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